Provider Demographics
NPI:1871808311
Name:BANSRI SHROFF, DMD PC
Entity type:Organization
Organization Name:BANSRI SHROFF, DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BANSRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-226-1100
Mailing Address - Street 1:899 S WEBER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5488
Mailing Address - Country:US
Mailing Address - Phone:630-226-1100
Mailing Address - Fax:630-863-7499
Practice Address - Street 1:899 S WEBER RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-5488
Practice Address - Country:US
Practice Address - Phone:630-226-1100
Practice Address - Fax:630-863-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty